THE CURRICULUM IN TRANSITION

Since the mid-1960s, there has been increased pressure from medical students to introduce greater flexibility into their courses of study. In response to this criticism, most schools have established committees (sometimes including students) to periodically reevaluate and update their curricula. In many schools, new curricula have been introduced that have modified the traditional program using one or more of several different approaches:

Determination of a core curriculum. This approach places the emphasis on principles rather than only on facts.

Greater correlation between basic and clinical sciences. In the first year, the student is exposed to some clinical experience by seeing patients having illnesses related to the subject being studied.

Greater emphasis placed on function than structure. This approach is reflected by a decrease in the amount of time allotted to morphological studies (anatomy, for example) and by an integration of material presented by different departments.

Introduction of multiple-track systems. This offers students who have completed the core curriculum, which is the required common experience of all students, to choose one of several pathways having different emphases, depending upon their ultimate career goals. Thus, there is a differentiation of exposure depending upon interest, need, and ability.

Use of interdisciplinary and interdepartmental courses. These frequently replace departmental offerings, especially in the basic sciences. The combined viewpoints of several basic medical sciences are presented in an integrated fashion as each organ system is discussed, rather than being taught in the classical manner at varied times through separate courses. The organ systems are muscular, skeletal, nervous, cardiovascular, respiratory, gastrointestinal, hematopoetic, genitourinary, integumentary, endocrine, and reproductive. This type of teaching is known as “back to back”; that is, the normal aspects of the anatomy, chemistry, physiology, and pharmacology are considered in relation to abnormal or pathological principles.

Use of visual aids. These and other modern methods of instruction are much more widely used, although their effectiveness cannot yet be evaluated.

Taking qualifying examinations. In many schools students are encouraged to take such examinations before beginning certain basic science courses. If successful, they may proceed to other areas or disciplines without further course-work in the subject they demonstrated competence in.

Introduction of more elective time. This permits the student to spend additional time in areas of special interest, thus facilitating the choice of and preparation for a specialty or becoming more proficient in a selected area.

A slow national trend toward sweeping curricular change with an emphasis on communication skills. Thus far these changes have taken place at Harvard University, University of Pittsburgh, Johns Hopkins University, University of Michigan, University of Toronto, and Northwestern University. Consistent with national trends, the new curriculum emphasizes active self-directed learning rather than rote memorization. The supporters of this change feel that medical “facts” become obsolete so quickly that it is pointless to force students to memorize them. Rather, they believe students should be trained to be “lifelong learners.”

Accelerating the program of studies. A very small number of schools have offered their most promising students opportunities to complete their studies in less than four years. The schools listed below have standard four-year programs and may offer an accelerated three-year option.

Baylor College of Medicine

Johns Hopkins University

Northwestern University

Ohio State University

SUNY at Buffalo

University of Illinois at Chicago

University of North Carolina

University of Texas Medical School at Galveston

University of Washington

A number of schools shortened their standard curriculum during World War II as well as in the early 1970s. However, the enthusiasm for the three-year program diminished markedly, and all schools now offer a four-year program as a requirement for all students.

A recent accelerated program has been introduced that incorporates the first year of post graduate training (PGY1) in the standard four-year MD program into a single unit. The goal of this program, which is so far offered only in a limited number of schools, is to encourage medical students to elect to enter primary care careers through family practice or internal medicine. You should inquire at your school of interest whether such a program is offered there.

Lengthening the program of studies. If it proves necessary, some medical schools permit students to extend their educational program for a year. Among such schools are:

Boston University

Creighton University

Howard University

Medical College of Wisconsin

Stanford University

University of California, San Diego

University of California, San Francisco

University of Hawaii

Arts and medicine. Many medical schools have arranged for their students, especially those considering a career in pediatrics, to participate in an Arts for Children in Hospitals program. It employs hands-on arts activities one on one or through music or dance sessions. The goal is to help medical students learn how to become comfortable with young patients.

Since there now exists a diversity of curricula because of the many possible variations, it is advisable for the prospective applicant to become familiar with the programs offered by the school in which they are interested (see individual school profiles, Chapter 7).